Question about United Healthcare Appeal

My mom is 62 and just had two major spine surgeries in one hospital admission. She also has multiple sclerosis. She has been in the hospital for a little over a week now and her medical team recommended her for the hospital's inpatient rehabilitation program. They attempted to get approval from her health insurance (United Healthcare Medicare) for this and it was denied. The denial stated that "Pt does not have the combined complexity of medical management, nursing & rehab needs for IP rehab care. However, would approve for SNF request if requested within the next 24 hrs."

First of all, I do not understand how they could state that she does not have the complexity of medical management needs for inpatient rehab. There is documentation from the hospital (which I can see on the hospital's online portal) repeatedly stating that she needs and is benefitting from physical therapy and occupational therapy, which is currently being provided at the hospital. As I stated above, on top of the fact that she just had two spine surgeries, she has a neurological condition. How much more complex could her medical needs be? She is definitely not at her pre-surgery baseline.

Also, the part that states they "would approve for SNF request if requested within the next 24 hrs" sounds like a veiled threat, honestly. The implication seems to be that if we do not accept a SNF, they will not provide any services at all. I am not sending my mom to a "skilled" nursing facility. She was in a SNF for rehab after a previous surgery and she had a horrible experience. I get the feeling that they want to deny inpatient rehab because it is more expensive than a SNF.

The social worker said that they are going to appeal the decision and we will have an "expedited" response within 72 hours. They are going to send more clinical documentation. My question is, do you think there is any chance that this appeal will actually succeed? I understand that nobody here has a crystal ball and you don't know all the details, but I'm just looking for an idea. If not, what can be done? Honestly, my current plan if they deny the appeal is to see if the hospital will discharge her with at-home therapy services. Thank you in advance.

TL;DR: UHC is denying my mom inpatient rehab after major surgeries, states they will approve a SNF. What are the chances the appeal succeeds?

submitted by /u/jag358
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